Interview with OhMD CEO Ethan Bechtel

0:00:11
Well, phone tag is brutal and no one reads their email, so it's pretty hard for patients and doctors to be in touch with one another. But almost everyone reads their text message is right when they arrive, and so wouldn't that be a better way to go? There's a few things that you have to worry about first though, like privacy and workflow. Hi, everyone. I'm David Williams, President of Strategy Consulting Firm Health Business Group and a host of the Health Business podcast, a weekly show where I interview top healthcare leaders about their lives and careers. My guest today is Ethan Bechtel, he is CEO and Co Founder of OhMD. HIPAA compliant texting and telehealth platform, so we're gonna talk about these very issues. Ethan, welcome to the Health Biz podcast. Thanks, David. Great to be here. Alright. Well, it's a great it's a great tea up.

0:00:54
So before we get to talking about texting, let's talk about your background, your your upbringing, What was your childhood like? You know, any childhood influences that have stuck with you in your career? Yeah. Quite a few. I I in a very entrepreneurial family. My mother was a business founder and just so happened to be in healthcare as well. So for those of you familiar with skiing, she was she opened the first orthopedic clinic at Killington Mountain Resort way back when I was a kid. And then went on to get her her master's in business. She was an orthopedic nurse practitioner. She was an x-ray tech. And just generally a healthcare expert all around. So when she started her business, it was to help doctors run their practices. And billing was hard. This is before software for billing. So in the in the eighties, And I grew up as a kid in in that business doing odds and ends. Not helpful things. For the most part, it was a lot of vacuuming and stampicking. For us patient statements going out the door. But that was kind of my introduction to healthcare. And so saw a lot of that happen and learned a lot. In the early days, I learned about revenue cycle, learned how to process payments, send out billing runs, and I have the whole process down. And so that was early days introduction to healthcare. Now that's probably come up.

0:02:29
So, Ethan, when you think about, you know, a Pedic Clinic near a near a ski resort. Of course, I'm sure you weren't doing this, but maybe as a local kid, you know, skiing down, challenging people to ski down some of the, you know, the the icy slopes depending on conditions and generating some new business from the clinic. I want I want to ask you to comment on whether you actually did that. But, yeah, there's plenty of orthopedic business near mountains, but it's also kind of complicated because people are either self payer, they've got insurance from every which way, and of course, they leave town you know, once they can walk or hop below there on on practice. So a great a great way to get you started. Yeah. Hey. And and my first job, I think I was making three dollars and ninety five cents an hour was at Sugar Busch as a ski instructor when I was fifteen. And so I know ski injuries having a few my own broken bones and was on the mountain a lot. So definitely familiar with the orthopedic world.

0:03:22
And part of actually my story in the early days in my own personal journey through healthcare was, I don't talk about this a lot. I was diagnosed with an orthopedic injury, just a fracture when I was in fifth grade of my left humerus. They went in and thought it was just a normal broken bone. It was actually it was kind of before a snowboard. It was the the snuffboard with the rope on the front. And so broke my arm. They went in. Of course, my mom was an orthopedic nurse practitioner. So she's watching them put the x-ray up. And you look at my humerus and it was just mangled. Yeah. It wasn't just a break. It was like what's called an aneurysmal bone cyst. It was it looked very scary. Both the doctor and my mom thought it was cancer. And learned a few days later that it was not. And I went on to break my left humerus twelve times over the next five or six years. And so did a lot of healthcare -- Yeah. -- of my own. And so I have a lot of personal experiences there that I think shaped the way that the way that I would ideally want healthcare to operate. So that weighs heavily on my, I guess, my mentality here. Got it. Well, you still you still seem to be moving your arm around so somebody must have done something right.

0:04:41
Actually, none of the surgeries worked, but I'm great. I haven't broken it in many years. I still do all the things I wanna do. I do a ton of skiing and everything else. So good. So what you do so it sounds like you were a ski instructor. Did you take any any classes you go to college or anything like that or just learn learned out on the slopes? I I I, you know, you get to just learn learn being on the mountain all the time. I I don't know that I took a ton of of instruction but ended up being I think it's probably the sport I'm best at. It doesn't mean that I'm incredible out there, but I'm very comfortable as a skier, in fact, traveling out to British Columbia next week to get some runs in in a a little bit different of a climate than Vermont. But, yeah, So good. A lot of And then and then so after you I know you did go to college.

0:05:31
So after that, the you were doing some stuff you got right back into healthcare, some nice some data related EMR Edge and MBA Health Group. What was that experience like? How'd you how'd you get into those companies? What'd you do once you were there? Yeah. NBA was the was the company that my mother founded. I joined out of out of college. I went to University of Vermont, studied business.

0:05:52
And saw an opportunity in the early two thousands for her business, which had about one hundred physicians using her revenue cycle management services saw an opportunity with the electronic medical record, didn't really know what the opportunity was, and half of it was really scary. Like, what's gonna happen when all of these doctors using your billing services, choose a an EMR software to document their notes that do their billing for them. And so part of that process for me was as an early employee was I was a marketing guy. And as time went on, ended up standing up a relationship with Allscripts in two thousand six because there were mostly because they were local. They were a few miles down the road from us, and and we created a relationship there that was really fruitful ended up getting us acclimated to all of the things that the EMR could do at the time and might do in the future, and we built a whole team around that. And so we built the company up to about a hundred people. Actually, just over a hundred people, mostly working on big Allscripts rollouts some epic rollouts and learned a lot about what we wanted to do in healthcare in the future. The potential to build software to solve problems, then maybe the EMR wouldn't. Great. So OMD. So let's talk about that. What problem were you trying to to solve with that company?

0:07:19
It's been a journey and certainly an evolution of thought early days, it was we were implementing patient portal, in small practices, in larger organizations, and what we found in two thousand nine, two thousand ten was it was hard to get patients to not just sign up for this thing, but to come back and use it. In the future for anything. And so I think what we extrapolated from that was that there were opportunities to focus on a particular pain point or value proposition. And and that ended up being around communication. We did we thought there were too many hurdles for the average patient to jump through, to sign up for a portal, remember their password. Now they have passwords for ten portals, and where do they go when they wanna send a message or when the phone doesn't work and no one answers, where do they go to have that conversation? And so early days with LMD, that was that was really our goal was to really simplify, use what we knew about consumer experiences and technology at the time. To just build a better experience around communication.

0:08:30
And there was one influence along the way a a a big help tech company here in Burlington, Vermont called IDX Systems. Yeah. And Rich Tarrant, who was their CEO at the time and co founder had a conversation with him, and he said he said Ethan, like, nice little consulting business you got over here, helping organizations implement the MR, why aren't you building your own software? You know all of the things that are going wrong. Pick something you're passionate about. Solving and build software around it. So he had planted that seed pretty early, and that's what got us thinking about it. And then years later, and turn it into a real company. Yeah. That's interesting. I I met Rich Tarrant back in those days, and I I think was it around that after he he sold IDX, he he ran for Senate. Right? He did. Yeah. Yeah. I don't know what year it was because I I believe Think about it was six. Yeah. IDX sold in, I think, two thousand five. So okay. That makes sense. Yeah. Yeah. So anyway, no. Very interesting. That's the other big health care company I could think in in Burlington. So -- Yeah. -- interesting spot for that. Okay.

0:09:37
So, you know, the portal was interesting. I think it's an example of when you sometimes people talk about, you know, patient centric practices and things like that. A lot of the early IT is is more kind of physician centric or health system administrator centric. And I think the portal is a good example. Right? It makes sense. It's you have all of your records there and things secure. You can sign in, but long the whole people don't do it. And I think under meaningful use, you know, the the practice is supposed to get people to use the portals, and it was a very low percentage, I think, originally, like, five percent of patients using it. And you can see that's just not gonna be the everyday kind of approach. So a lot learned about that. Now I understand just by looking at your website that you got led into eventually into focusing on on text messaging as kind of the the entry point. How did you get to to there? And then, you know, what what what have you done with that insight? Yeah.

0:10:34
I think we always believed that messaging was the mechanism by which conversations could be had in the most efficient way because we as kind of a younger team at the time had had kind of like followed the trajectory of technology adoption in groups of younger people, watched how that kind of trickles up you know, back to think about Facebook in the early days. It was a few Boston colleges that started using it. And and a few years later, everyone's grandma, using it. And and this is just kind of like where technology adoption begins is sort of in the younger demographics. So we we thought that messaging would be the conduit. And so in the early days, we built an app. It was kind of a WhatsApp for healthcare patients would download the app, they'd still have to go through a registration process. And then years later, evolved into leveraging SMS for pure SMS messaging around appointments to encrypted links that are sent out over SMS when you could have entirely secure conversation through an encrypted link.

0:11:46
And, like, really stripping out a lot of that, like, registration and and front loaded work that the patient has to do. And I think a lot of it just comes back to user experience and and what we learned from looking outside of this vertical. Rather than trying to reinvent the wheel and back to your point, go top down on this stuff. Like we have in healthcare forever, where the C suite makes all the decisions and the patient is just like an afterthought. We thought the patient needed to be like the group of people we were solving this problem for because if you aren't solving a problem for the patient, then they're not going to use it. If they don't use it, it's not valuable to the organization. And so we started with the patient. We always built for the patient first. And then we said, we gotta we gotta build a business here now, and we have to figure out how to sell this into organizations that find value. So that was the direction that we took rather than going top down.

0:12:44
You know, there were a number of businesses that came out of the provider side in in texting space some years ago. And what I think what had happened is you had all these these sort of top down systems also from the staff or the physician perspective. And, you know, people are used to texting in regular life, and so the talkers are just text one another, which wasn't a secure thing. And so they had some, you know, secure texting for physicians in the hospital. So this is, I think, a logical you know, next step to go from there. So -- Yep. -- you know, as you need to make a a business, it's not just say people like to text, but, you know, what is when you when you're looking for customers that are actually gonna be paying, you know, what is the value proposition that you put out there? And who is the customer? What is the segment that you that you look at? It's the segment is evolving and the reason we think that's happening I'll get into just kind of the value proposition as well.

0:13:38
But when you think about all of the moving parts in staffing in healthcare today and one in five doctors have either left or are in the process of leaving healthcare and even a higher percentage of healthcare workers, nurses, administrative staff, aren't leaving healthcare. You have all of this, I guess, uncontrolled workload and and bandwidth that cannot be met by the existing staffing. And so the the pain point which was first felt in the smaller practices, which is where we started, and is now felt in larger organizations, which is kind of where we've been successful over the last two years is the phone never stops ringing. Eighty percent of patients are not picking up the phone when I call them. And so all it ends up being is a lot of work that never really accomplishes anything.

0:14:35
There was an article in the New York Times maybe Friday or over the weekend And the word that this physician used was it's demoralizing to be a physician. Yeah. Because it's not just about burnout. And workload. It's like the system doesn't do what you what you always thought it would do when you went to medical school. It wasn't it isn't taking care of patients the way you wanted to and nothing's changing. And so anyway, the pain point is too much work. Not enough patient interaction, whether that's in person or or once they've left the office.

0:15:10
And the value proposition then is how do we give your team and US physicians more time back in the day? To do the things that you got into medicine to do. How do we for practices that are looking to grow, how do we streamline operations so that you can actually grow? How do you deliver a higher level of service? Because maybe you're maybe you're contracted on a value basis in some cases. So how do we give you the conduit to reach your patients to keep them healthy? And those are the value props that we kinda go to market with, and every practice is different. It depends on all sorts of things. But at the end of the day, I think everyone agrees that better communication with patients is is really the only way to drive improved outcomes, build and operate an efficient practice And in many cases, get home if you're a physician, get home on time to have dinner with your family.

0:16:08
So So when you look at, you know, putting a proposal forward and how it's evaluated. Are there of hard numbers that you can use? Hey. One thing that's, yeah, nice for the physician to get home and and, you know, to have get around the the other the practice may or may not care about that except to the extent it keeps that physician coming back. But are there things like, you know, reduction of missed appointments or or other things that are a pain point for practice that they can measure. And so, yeah, that that's valuable I I would pay for that. Yeah, absolutely.

0:16:38
I think, again, depending on the type of the practice, it's a practice focused on growth and referrals are important or patients coming in and acquisition is important. We have hard numbers on drop off if you have a patient required that they pick up the phone and call you to schedule an appointment -- Yeah. -- versus lowering the hurdle there so that they can just send a message and go down that path without having to wait on hold or wait for a callback or any of that. So patient acquisition ROI is a big one, but I think there's a lot of reducing those shows. There's a lot of improvement in revenue through being able to not just make sure patients show up for their appointments, but but use the platform to conduct a video visit or in some cases a billable interaction that is messaging based. So there's a lot of different, again, your average ortho practice is very different from your average pediatrician is very different from any larger hospital in the way that they think about their call centers. But we it's communication and we've simplified it so that the patient will use it and we've made it comprehensive enough so that within an organization, it fits within the workflows and integrates within the systems they needed to. And and so works to solve a number of of these types of problems.

0:18:00
You know, back in the olden days, way, way back, I guess, it was a big deal to get a phone call, but then more in my my recollection, you know, and they they sort of make funded the AOL, you know, you've got mail. It used to be a thing, hey, I got an email, you know, and so it wasn't cluttered. And if you had an email, that was a special thing. Now maybe you weren't getting it all the time because you weren't online, you'd have to dial up and it would say that. And text is is more immediate. But how much of that is just the absolute nature of text and how much is it just, okay, that hasn't been overcrowded yet, and I'm not totally spanned out you know, on on Texas. I have a number of messaging apps. I do get spams and phishing, you know, in my my text and and some other kind of, you know, messages you you mentioned WhatsApp as other players out there.

0:18:43
How how do you think about text?

0:18:45
Is that, like, the ultimate place to go? Or what where do we go from there? It's gonna continue to evolve. And I I don't think we we as a company aren't married to any particular conduit Text today is is one hundred percent the simplest conduit to reach a patient without it out. You know, that that could evolve over time. But the way that we've we've engineered the product is that it can evolve over time. And if if something changes in the way that we use technology, we can adapt to that. But but fundamentally, we've built this thing where it's it allows a practice to manage their relationship with a patient -- Yeah.

0:19:26
-- over a conversation, wherever that conversation happens. And I actually think that I find myself preaching about the value of text a lot. I actually see a lot of value in being able to get a hold of someone on the phone and have no conversation. I think a lot of people find value in that. It's not that we don't find it valuable. It's that it rarely happens -- Yeah. -- because we're all busy. And it's hard to synchronously catch up with anyone. And that goes for, you know, work, it goes for family, and whatever. If we could all get a hold of each other on the phone, whenever we made a call, that'd be fantastic. It's just not the world we're living in. So I think we need to be able to be flexible about the way that we think about how conversations change and adapt our product as time goes on.

0:20:12
Howard Bauchner: So you mentioned physicians or physician practices being customers here and they've got a value proposition you can sell to them and so on. But that's also kind of a stressed out part of the healthcare ecosystem. Are there other customer types that you either sell to now or are contemplating? Yeah. We've seen six success with different types of payers that are focused on certain types of programs that require that they reach patients. I think there's a lot of a lot of our customers are involved in ACOs and are focused on how to make sure that they keep their patients out of the emergency room. Yeah.

0:20:51
And so I I think that one of the biggest challenges for me with, you you think about, you know, your your average graduate degree in business and and how many times people hear that you really need to focus on a particular market segment to be successful. It's been a challenge for us doing that because the way that we've built this business, we've determined that every single type of practice needs to have conversations with patients and those conversations need to be flexible and they could contain any type of input and output. So I I I look at as an analog that the office telephone is sitting there on the desk and it -- Yeah. -- it looks the same. In an orthopedic practice as it looks in a pediatric practice. And and OMV solves for the same the same problem. The conversation doesn't happen on the phone the way we wish it did. LNV needs to be as flexible as it has as any of those practices needed to be. But in doing that, it it's harder for us to focus on a particular specialty today. I think that's something that will change within within the way the product functions as we can leverage different types of artificial intelligence to make it easier to have these conversations. And I'm excited about what's possible there as well as time goes on.

0:22:12
So when you are marketing to physician offices, you know, it's it's not exactly kind of business to consumer, but there's a lot of small customers that are that are out there even though a lot of them are within physician group, within larger integrated delivery networks as well. And that requires, I would imagine, some capital, some heat on the streets. How have you financed the company? And what's been the strategy there? Yeah. I don't wanna give away all the secrets. Yeah. We don't we don't have done this differently. Yeah. If if you look us up online and you'd look at crunch based, like, we haven't raised a tremendous amount of money And a lot of that has to do with the way that we've built our marketing funnels and and the way that we've used just expertise that the team has built up over years, and and I've been involved in over years to build content that that our, yeah, our our core market is looking for on the Internet and be there everywhere organically. Yeah. That's what we've done really well.

0:23:15
So when you talk about feet on the street, there was a time way back that I thought that we'd need to take the zocdoc approach and have people running around, literally knocking on position offices doors. And and what we determined is that we could build an organic funnel and really inexpensively grow the company. And we've continued to be amazed by what's possible when you focus on organic first and ended up building a really sustainable company. We're growing really quickly and everything's really exciting, but we did a tremendous amount of venture capital to make that happen. We've had great investors, family office investors, and more recently, FCA Venture Partners led our round in actually almost a year to the day ago. I think it it would be tomorrow a year ago. That's a great So so we have our venture capital and it's helped us grow faster and it's a fantastic thing, but we've been we've been growing differently than most companies. Sounds good. Now you're hinting a little bit about the future in terms of the use of AI, but what do you see kind of coming down down the road for OMD.

0:24:26
I talk a lot about the importance of human interaction in healthcare. And I say this over and over and over. But like, healthcare is unique in that it's so emotional and it's often painful and we've all gone through it we all continue to go through it. And the human connection is really, really important. And and we've always believed that because if we didn't, then when we founded this company, we would have focused on automated appointment reminders. We didn't do that. We focused on what brings value to the patient and we always believe that when you're a patient and you need to have a conversation or you're worried about your lab results, or you're sick and you no one's helping you. That's not a problem an AI consultant for you. That that requires oftentimes a human interaction. And so the way that we're going to continue to evolve is focusing first and foremost on efficient conversations and and human connections, and then enhancing that and enriching it with technology where it makes sense.

0:25:30
So that doesn't mean let's automate everything because I don't believe as time goes on, we as consumers are interested in being automated away in healthcare. Maybe we are when our airline changes our gate and we wanna get that automated message because that solves a really important problem and I didn't need a person to talk to to tell me that. But when I have ongoing, you know, headaches or or different symptoms that that I can't pinpoint, and I end up with with thyroid, you know, some sort of auto immune disorder, which I've had, and it took me six years to get it diagnosed. Yeah. I had given up on getting that solved because No one was helping me, but the way that I thought I needed it, it required real human interaction to get me to a point where I felt like I was being taken care of, and I believe that's the future for HomeMD as well as to continue keeping true to what we've always believed and building around that in ways that can enrich the experience.

0:26:27
So, yeah, it sounds like you're a lifelong Vermont or And it's a great state. You'll love to go and visit there. And I see you're involved in the greater Burlington Industrial Corporation. So I'd love to hear about that. I mean, when I think about Vermont, you know, we mentioned a couple of high-tech companies there, IDX, yourself, you know, mentioned Allscripts was was was working there. As well. I think it's the state, the second oldest in terms of the average age of people that I think only Maine is ahead of that, and then I think New Hampshire and Massachusetts is up there too, but not all the way up there. How do you think about, you know, promoting growth there? What's kind of the economic future of Vermont? Yeah, I think we do have an aging population, and that's a problem. Like a lot of rural states, that that is a problem that we are all facing.

0:27:20
I I do think Vermont is unique in a few ways. GBIC in particular. I mean, they many, many years ago were the ones that brought IBM into Vermont and they built a massive campus here, which really was the the biggest economic force driving driving Vermont for decades. And so my involvement in GBIC has given me insight into, like, local economy issues where mostly I'm focused on more broadly healthcare problems. And what I've learned is that we have a lot of value here in business that is legacy and has been here a really long time. And and we hope continues to build here. And then we have this new age of companies that go back to IDX systems, you know, sold in two thousand and five. I believe dealer dot com was was sold to Cox Automotive in maybe two thousand ten. Billion dollar exit. We've got beta technologies here, building EV planes with, you know, hundreds of millions or four billion in investment. And so we have this like tech hub here in Burlington that I expect to continue to thrive. And so we have that.

0:28:40
And then I think we're also what we've learned during the pandemic is that this is a place people want to be, especially when it's warm out, maybe not when it's cold out. But but definitely when it's warm out, the lake is beautiful. The town is beautiful. And so I think we're going to continue to attract people, smart people that don't want to live in the city anymore and want to be able to work in an environment like So love Burlington. I I can't say enough good things. We're we're very fortunate to be here. Great.

0:29:10
Well, I drive through there all the time on my way to Montreal. I've stopped a couple times, and I've always enjoyed it. And I I like it when it's cold actually, because that means, hopefully, there's decent ski conditions. That are out there. So If you're not a skier, winters are miserable. Yeah. Fair enough. So last question for you, Ethan, is if you've had a chance to read any good books lately anything you would recommend to the audience or conversely if you have read anything that you'd say, stay away from that. I have a sixteen month old, and so I've been reading a lot of one year old books that are fantastic. Probably not great for your audience. So I'll I'll skip to the other book that I've read recently.

0:29:52
I was struggling with understanding how people communicate and and how frequently we get distracted. But I think -- Yeah. -- like, phones are on the table always and no one's really listening to anyone. So I found this book, I believe, I can I can be on my desk? Kate Murphy is the author.

0:30:11
The book is called, you're not listening. And it there really is just a a deep dive into why we are why we're always thinking about the next thing that we're gonna say. So we don't sound stupid. Or so that we so that we are always like, you know, we're we're lining something up to continue the conversation. Instead of actually, like, taking a minute to listen to the words that someone is saying. And that doesn't mean everyone always has something valuable to say. Some people don't, and that's okay. But many people do. And so if you could just be able to focus on how how those words are coming out or what they're talking about, I'm trying to internalize those things in, like, process. I think it it changes the way you have conversations with people and and allows you to focus on other people talking instead of instead of you, which I think is a a a valuable characteristic to have. I'm gonna continue working on it. Sounds good. I haven't read that book.

0:31:10
Do you do you respond to all your text messages? I that's a great question. I tried to, but that's hard too. Finding myself getting backed up on text messages more than I probably should, considering what I do. That's okay. Well, there's the old thing about the the college son going without the shoes, but that's we'll we'll count you to I won't send you any text. I'll send you I'll send you an email and I'll call you.

0:31:35
But In any case, my guest today has been Ethan Bechtel, CEO and Co Founder of OMD, which is a HIPAA compliant texting and telehealth platform. Ethan, thanks for joining me today on the Health Business podcast. Thanks so much. I really appreciate it. You've been listening to the Health Biz podcast with me. David Williams, president of Health Business Group. I conduct in-depth interviews with leaders in healthcare business and policy. If you like what you hear, go ahead and subscribe on your favorite service. While you're at it, go ahead and subscribe on your second and third favorite services as well. There's more good stuff to come and you won't want to miss an episode. If your organization is seeking strategy consulting services in healthcare, check out our website health business group dot com.